2 pointsDear Dr. Johansson, It is a great blessing to live at a time when a community of professionals can come together through online forums or in-person meetups to pool their scientific and medical knowledge, experience and wisdom to further education and advancement of science and medicine. 99nicu.org has done wonderful work in this regard in the field of neonatology and I feel blessed for us to be able to be a part of it. I am still working on my schedule to see if I can come to the planned Vienna meetup in April. Distance is far and scheduling difficult for me but it is a meeting I really would like to attend and in a city I really like to visit. We are proud and honored to a be Supporting Partner of 99nicu.org. We are still a very early and young medical device company but have come a long way in a short time. In 2018, as we commence our crowdfunding campaign and raise the funds for further research and development, we will be putting together the medical advisory team to draft our clinical trial protocols and hope to commence clinical trials for Amnionbed in 2019. I believe the pool of medical experience and knowledge at 99nicu.org is a tremendous blessing that can help us in this regard which I am happy and honored to be involved with. Best of luck in Vienna and hope to be able to meet some of the members in person soon. Sincerely,
1 pointthank you for such an insightful comment and refreshing all of our memories regarding Dr. Wung's incredible results
1 pointGlad you presented this issue. It has been festering in me for over 45 years. The BVM has been in the delivery room and at the bedside even before neonatologists existed. The standard approach to a distressed infant was to vigorously “bag him up” to relieve immediate symptoms. The original Baby Bird ventilators had a resuscitation bag incorporated within the ventilator circuit to allow for “bagging up” the infant whenever heart rate dropped or desaturation seemed likely (prior to pulse oximetry). An unacceptably high rate of pneumothoraces and associated barotrauma prompted Bird to remove the resuscitation bag from subsequent Baby Bird models. There is ample evidence to support the notion that the BVM may be the sole cause of infant CLD. Certainly there are contributing factors that predispose the immature lung to be susceptible to overdistension. Other than congenital emphysema, however, one would be hard pressed to document a case of CLD in which the infant had not received BVM ventilation. Columbia Presbyterian neonatal unit has shown an unusually low incidence of CLD as compared to most other hospitals. The practice of adopting Dr Wung’s “bubble CPAP” and low pressure and/or low volume ventilation has led to improvement in neonatal outcomes in many hospitals, but matching Columbia Presbyterian’s results has been an elusive goal for most. A possible reason is that others have failed to adopt the delivery room and neonatal unit discipline instilled by Dr Wung that accompanies the practices they’ve adopted. “Give the baby a chance” is Dr Wung’s mantra. The first apgar is at one minute, not at 20 seconds. This simple act reduces unnecessary interventions and subsequent iatrogenic actions. Outcomes improve. Immediate CPAP application to premature infants is a second action rather than resorting to BVM “rescue”. Again, “Give the baby a chance”. Refer to Dr Jobe at Cincinnati Children’s article, “Don’t just do something, stand there!” Follow-up care in the NICU is equally fraught with iatrogenic actions prompted by good intentions. Infants receiving mechanical ventilation are routinely “bagged up” for desaturation or bradycardia episodes. Again, the immature lung is subjected to stresses it simply cannot tolerate. There are few, if any, studies on how often and to what extent BVM interventions happen. Virtually every study of neonatal mechanical ventilation is skewed by this glaring oversight. Until the role of BVM is thoroughly investigated and quantified, progress in neonatal CLD will continue to be elusive.
1 pointNeed more details to give concrete advice: 1) What are your goals in conducting simulations? 2) Who are you targeting? (MDs, RNs, NNPs, RTs, all of the above?) 3) What resources do you have? (It would be stupid of me to tell you about fancy high fidelity simulators if you don't have that sort of infrastructure) The one universal I can endorse is that everyone needs to buy into the fact that these are done for the good of our patients and there can be no judgement. At our institution, that means the no information on individual performance ever gets reported outside the people at that specific mock code. It has to be 'ok' to fail in the mock code.
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